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Abstract: The patient, a 47-year-old woman, reported that she had been experiencing spasms at the corners of her eyes accompanied by spasms at the corners of her mouth and face for more than 2 years, and after visiting an outside hospital, she chose medication. At first, the medication was effective, but after a period of time the medication could no longer relieve the symptoms of facial spasm, so she came to the clinic. After completing various examinations, the diagnosis of facial spasm was clarified, and since medication was ineffective, the patient was given surgery.
Basic information】Female, 47 years old
Disease Type】Facial spasm
Hospital】Beijing Tiantan Hospital
Date of Consultation】August 2019
Treatment plan】Surgical treatment (microvascular decompression)
Treatment Period】7 days of inpatient treatment
Results】Facial muscle spasm symptoms disappeared
I. Initial consultation
A female patient came to the clinic and reported that she had facial spasms for more than 2 years. At the beginning, she only showed spasms at the corners of her eyes, and at that time, she only thought that it was caused by cold, so she did not go to the hospital for consultation. After a period of time, spasms at the corners of the eyes began to appear along with spasms at the corners of the mouth and face, and the spasms even tended to worsen when emotionally excited, which then affected the opening of the eyes and mouth. After visiting an outside hospital, the doctor recommended surgery, but he did not agree to it because he was worried about the effect of surgery. At the beginning of the oral medication, the effect was good, but after a period of oral treatment, it was found that the treatment gradually began to be less effective and the symptoms recurred. For further diagnosis and treatment, he came to the clinic. Based on the patient’s clinical symptoms, the patient was initially considered to be suffering from facial spasm, and was admitted to the hospital for a clear diagnosis.
II. Treatment process
After admission, the patient underwent further examination. No significant abnormalities were found on physical examination, and a cranial MRI was performed, which showed the presence of facial nerve compression. The patient was advised to undergo microvascular decompression surgery, which is a minimally invasive procedure with faster recovery and better therapeutic effect and less chance of recurrence after surgery.
The patient agreed to the operation, so he was given a complete preoperative examination and no obvious contraindications to the operation were found. The patient was given microvascular decompression the next day to relieve the facial nerve compression, and the operation went smoothly. After surgery, the patient was closely observed and psychological support was given to make him emotionally stable.
III. Treatment effect
On the second postoperative day, the patient reported that the facial muscle spasm symptoms had diminished, but he felt a numbness in his face, which was considered to be related to postoperative adverse effects, and functional exercise was recommended. After 7 days of hospitalization, the patient’s facial muscle spasm symptoms disappeared. At this time, after a period of functional exercise, the facial numbness was weaker than before, while the patient’s general condition was better, no tinnitus or hearing loss occurred, and a repeat cranial MRI indicated that the compression disappeared, indicating that the treatment was effective. The patient’s psychological status also gradually changed from nervous and anxious when he was first admitted to cheerful and enthusiastic. The patient was discharged from the hospital after meeting the discharge criteria.
IV. Notes
After the treatment, the patient got good results, which made me more pleased, but for the sake of the patient’s health, I still patiently advised the patient to pay attention to the following points in daily life when discharged.
1. Since facial sensory disorders may occur in the early stage after microvascular decompression, patients need to pay attention to avoid overheating or overcooling of the washing water in daily life, and to protect their faces when going out, they can wear a mask to avoid unnecessary damage. When using skin care products, try to use products that have been used previously and are not allergic.
2. In terms of diet, take a warm, light, high-protein diet, such as egg custard, milk, soy milk, etc. At the same time, you can eat vitamin-rich fruits and vegetables, but pay attention to choosing soft, rotten food items, such as bananas, tomatoes, etc. Avoid eating spicy and stimulating diet, such as chili peppers, alcohol, etc.
V. Personal insight
Facial muscle spasm is more common in the clinic, mainly manifested as twitching at the corners of the eyes, mouth, and the face, with different degrees of twitching and aggravated by mental tension and excitement. The cause of facial myoclonus has not been clearly defined, but it is common after wind and cold, and the population of middle-aged women is preferred for many years. In this case, the patient’s symptoms were consistent with facial myospasm, and the disease was diagnosed after clear examination. For the treatment of facial myospasm, it is generally divided into conservative treatment and surgical treatment. In this case, the patient chose surgical treatment after the medication was ineffective, and the final treatment effect was satisfactory, which also shows that in the treatment of facial myospasm, the treatment method can be chosen according to the specific symptoms of the patient.